Patients at Risk

Nurse practitioner and physician assistant use are often justified because of a shortage of physicians, especially in underserved areas. One major cause of the physician shortage is a lack of residency positions, the required minimum training that must be completed after medical school to be licensed as a physician. Every year, thousands of aspiring physicians cannot complete that training because of a lack of funding for more residency positions. While physician advocacy groups are lobbying Congress for more residency funding, some doctors are taking direct action to help medical school graduates to continue their journey toward becoming licensed physicians. Today we are joined by Mary Tipton MD, an internal medicine and pediatric physician, who has created opportunities for unmatched medical school graduates to gain additional training and experience at her medical clinic. Contact Dr. Tipton at Mary.tipton@copperviewmedical.comPhysiciansForPatientProtection.org

The COVID19 pandemic created both challenges and opportunities in the healthcare sector. One major winner: telehealth startup companies offering ‘virtual’ medical care, including psychiatric care. But instead of hiring physicians, these companies hire nurse practitioners to care for some of the most complex and vulnerable patients in our nation. These companies got an even bigger boost when the U.S. Drug Enforcement Agency relaxed requirements for the prescribing of controlled substances due to the COVID19 pandemic. Online mental health companies quickly shifted gears to prescribing medications typically available only through a face-to-face visit, especially stimulant medications for attention deficit hyperactivity disorder (ADHD).Today we are joined by psychiatrist Ziba Rezaee, MD to help us understand the rise of for-profit online mental health companies and the risks to patients. Learn more: https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164Physicians, join us: physiciansforpatientprotection.orgPhysiciansForPatientProtection.org

Nurse practitioner and physician assistant advocates often assure physicians that they face little liability or risk when performing supervision, insisting that NPs and PAs are liable for their own errors. But case law examples demonstrate this to be false. If state law requires physician supervision or collaboration, the physician may be held vicariously liable in the event of negligence, even if they were not consulted by the nonphysician about the patient’s care.Today we are talking with Nancy Berley MD and Shenary Cotter MD,  family physicians who experienced negative repercussions when errors were made by associated nonphysicians.PhysiciansForPatientProtection.org

Imagine this scenario: You are rolled into an operating room in a surgical center for an outpatient elective procedure. But when you wake up; you’re in an emergency department, and you learn that you nearly died from anesthesia complications. Even worse, you find out that your anesthesia was provided not by an anesthesiologist, but by a nurse anesthetist.Paul Ambruster discusses his near-death experience after receiving anesthesia from a CRNA without anesthesiologist supervision. This is a cautionary tale for patients and physicians involved in the care of surgical patients. PhysiciansForPatientProtection.org

Physicians train for at least 15,000 hours before we are permitted to practice independently, and one of the reasons is that it takes a long time and a lot of patient volume to be exposed to the many different presentations of disease processes to learn how to recognize true emergencies that need immediate interventions. Today’s guest brings us a perfect example of the importance of this training. Karen Wilson Saintsing DVM is a veterinarian who nearly lost her arm after a nurse practitioner in an urgent care failed to recognize the onset of compartment syndrome. Fortunately, an astute emergency physician immediately recognized the condition and transferred her to a surgical center for treatment.  To help us understand compartment syndrome, we are also joined by trauma surgeon Stephanie Markle DO MPH.PhysiciansForPatientProtection.org

Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer. Colorectal surgeon Amer Alame MD discusses the flaws in a study that claims to show that PAs can safely perform colonoscopies.Fejleh MP, Shen C, Chen J, Bushong J, Dieckgraefe, B, Sayuk G. Quality metrics of screening colonoscopies performed by PAs. JAAPA. 2020;33(4):43-48.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

Increasingly, nurse practitioners and physician assistants are being asked to step into the role of physicians. While surgeons and procedural doctors have been fairly insulated from this phenomenon, the tide is beginning to turn. Today we are going to explore the phenomenon of NPs and PAs performing colonoscopies, screening tests for colon cancer. Colorectal surgeon Amer Alame MD discusses the flaws in a 2020 Johns Hopkins study advocating for the use of NPs to perform colonoscopies.  Riegert M, Nandwani M, Thul B, Chiu AC, Mathews SC, Khashab MA, Kalloo AN. Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients. Endosc Int Open. 2020 Oct;8(10):E1423-E1428. doi: 10.1055/a-1221-4546. Epub 2020 Sep 22. PMID: 33015346; PMCID: PMC7508647.Get the book! https://www.amazon.com/Patients-Risk-Practitioner-Physician-Healthcare/dp/1627343164/PhysiciansForPatientProtection.org

Tired of being owned by corporations, but don't want to open your own practice? Stephanie Freeman, MD, a critical care physician and entrepreneur, teaches physicians how to become self-employed through contract work and locums.  Learn more at DrStephanieICU.comhttp://www.freelocumstraining.com for free online locums training.National Association of Locums and Independent Physicianshttp://www.na-lip.comPhysiciansForPatientProtection.org

In Jan 2022, the Journal of Nursing Regulation published an article entitled: Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency DepartmentsThe summary:  “Due to the variability in educational preparation, NPs should not perform independent unsupervised care in the ED regardless of state law or hospital regulations.” This unequivocal statement contradicts the rhetoric of NP leadership which insists that NPs should be allowed to practice virtually anywhere and everywhere without supervision. Today I’m joined by family physician Christopher Garofalo, and radiologist and PPP board member Phil Shaffer to discuss this important paper. PhysiciansForPatientProtection.org

Attorney and emergency medicine physician William P. Sullivan believes that nonphysician practitioners should practice independently, but be held to the same medical standard as physicians since NP/PA leaders argue that there is "no difference in the practices and outcomes between physicians and advanced practice providers." Dr. Sullivan joins us to discuss his article on this issue - https://sullivanlegal.us/nurse-practitioner-and-physician-assistant-standard-of-care/Get the book! https://www.amazon.com/dp/B08M9YJQR3/PhysiciansForPatientProtection.org